NYMC Faculty Publications

In COVID-19 Patients Who Suffer In-Hospital Cardiac Arrest, Cardiopulmonary Resuscitation Outcomes May Be Impacted by Arrest Etiology and Local Pandemic Conditions

Authors

Charles G. Murphy, Columbia University Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, New York, NY.
Mia S. Nishikawa, Department of Medicine, Columbia University, New York, NY.
Steven T. Char, Department of Medicine, Columbia University, New York, NY.
Samantha K. Nemeth, Columbia University Center for Innovation and Outcomes Research, New York, NY.
Madhavi Parekh, Columbia University Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, New York, NY.
William A. Bulman, Columbia University Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, New York, NY.
Caroline Wu, Department of Surgery, Columbia University, Center for Innovation and Outcomes Research, New York, NY.
Gerald W. Neuberg, Columbia University Department of Medicine, Division of Cardiology, New York, NY.
Irene K. Louh, Columbia University Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, New York, NY.
Neil W. Schluger, New York Medical College School of Medicine, Department of Medicine, Valhalla, NY.Follow
Kenneth M. Prager, Columbia University Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, New York, NY.
Katherine N. Fischkoff, Columbia University Department of Surgery, Division of General Surgery, New York, NY.
Kristin M. Burkart, Columbia University Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, New York, NY.

Author Type(s)

Faculty

DOI

10.1097/CCE.0000000000000605

Journal Title

Critical Care Explorations

First Page

e0605

Document Type

Article

Publication Date

2-1-2022

Department

Medicine

Abstract

OBJECTIVES: The utility and risks to providers of performing cardiopulmonary resuscitation after in-hospital cardiac arrest in COVID-19 patients have been questioned. Additionally, there are discrepancies in reported COVID-19 in-hospital cardiac arrest survival rates. We describe outcomes after cardiopulmonary resuscitation for in-hospital cardiac arrest in two COVID-19 patient cohorts. DESIGN: Retrospective cohort study. SETTING: New York-Presbyterian Hospital/Columbia University Irving Medical Center in New York, NY. PATIENTS: Those admitted with COVID-19 between March 1, 2020, and May 31, 2020, as well as between March 1, 2021, and May 31, 2021, who received resuscitation after in-hospital cardiac arrest. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Among 103 patients with coronavirus disease 2019 who were resuscitated after in-hospital cardiac arrest in spring 2020, most self-identified as Hispanic/Latino or African American, 35 (34.0%) had return of spontaneous circulation for at least 20 minutes, and 15 (14.6%) survived to 30 days post-arrest. Compared with nonsurvivors, 30-day survivors experienced in-hospital cardiac arrest later (day 22 vs day 7; = 0.008) and were more likely to have had an acute respiratory event preceding in-hospital cardiac arrest (93.3% vs 27.3%; < 0.001). Among 30-day survivors, 11 (73.3%) survived to hospital discharge, at which point 8 (72.7%) had Cerebral Performance Category scores of 1 or 2. Among 26 COVID-19 patients resuscitated after in-hospital cardiac arrest in spring 2021, 15 (57.7%) had return of spontaneous circulation for at least 20 minutes, 3 (11.5%) survived to 30 days post in-hospital cardiac arrest, and 2 (7.7%) survived to hospital discharge, both with Cerebral Performance Category scores of 2 or less. Those who survived to 30 days post in-hospital cardiac arrest were younger (46.3 vs 67.8; = 0.03), but otherwise there were no significant differences between groups. CONCLUSIONS: Patients with COVID-19 who received cardiopulmonary resuscitation after in-hospital cardiac arrest had low survival rates. Our findings additionally show return of spontaneous circulation rates in these patients may be impacted by hospital strain and that patients with in-hospital cardiac arrest preceded by acute respiratory events might be more likely to survive to 30 days, suggesting Advanced Cardiac Life Support efforts may be more successful in this subpopulation.

Share

COinS